There has been much heated debate over the implementation of the Working Time Directive (WTD) in the NHS by this August. Contrary views have been expressed in different specialties, with requests from many to postpone the deadline in order for lagging trusts to comply with the requirements.
The Royal College of Obstetricians and Gynaecologists (RCOG) supports the principle of reducing junior doctors’ working to 48 hours. The changes should provide better quality of care for women and better work-life balance for trainees.
Emergencies in childbirth can occur at any time of the day or night and such incidents are likely to be more in the larger units. This level of intensity means that 13 hours are what we believe the trainees can cope with, even if they themselves feel they can do more. Working beyond this period of time may compromise care. In order to achieve higher quality of care and to maximise training through the use of every emergency episode as a training opportunity, we need a senior doctor to be present.
We are exploring new working patterns that balance cover with supervision and training to ensure safety in the labour ward. Currently, we depend heavily on our trainees and many provide the out-of-hours service, during the time of the night when major obstetric incidents can occur. Many of our middle-grade trainees are experienced and very capable but nothing compares to having a senior consultant on the ward during these crucial hours of the day or night. Our proposal is radical, and may meet with resistance but it will help meet WTD regulations, provide better care for women and more hands-on training under supervision.
We have had difficulties in recruitment into our specialty, partly due to the intensity of work and poor work-life balance. This will not be the case in the future with the WTD. We should absorb the current pool of trained doctors as consultants. Until additional numbers of consultants become available, some senior consultants may have to work in shift patterns which include unsocial hours. However, this should be compensated by an appropriate rest period after the shift. This may not be a popular move and we may be accused of taking a retrograde step but emergencies in childbirth are unpredictable and those of us who decided on a career in O&G did so because we enjoy the challenge of caring for mother and baby which is a 24-hour job.
Patient safety, access to services and good quality training are our priorities. The solution isn’t in hiring more trainees as you run the risk of too many consultants chasing too few jobs in years to come. We need sustainable development in our specialty and we believe this includes exploring increased consultant presence in the labour ward.
● The RCOG and Royal College of Paediatrics and Child Health published a joint report in July last year which highlighted the issues and offered practical solutions.
Tags: Patient safety, RCOG, Training, WTD
Good luck with getting senior O&G bods working anti-social shift patterns!!! Can’t see it at my place. The real answer, however, lies in interpreting the 48 hour week a bit more flexibly - as our European cousins are - and enable those juniors who want a bit more training time to have it. It’s better than panicking, throwing all the service delivery on to consultants and ending up with a load of under cooked trainees.